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Importance of patient selection to minimize bleeding

Selection of patients for anticoagulant therapy is key. The benefits and risks of therapy should be assessed prior to beginning an anticoagulant and continuously while on therapy. Bleeding risk assessments have been proposed, however they often correlate with stroke assessment scores whereas the higher the risk of stroke the higher the risk of bleeding, which presents difficulty. Someone with a recent history of major bleeding or at high risk of major bleeding should be anticoagulated with extreme care. Past history of bleeding predicts future risk, therefore patients should be counseled carefully as to the signs/symptoms of bleeding.

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